Dialysis Access Maintenance and Declots
Learn and improve your dialysis access maintenance, declot procedures, and interventions with expert-led guidance with five basic to advanced modules.
What does your patient workup look like for a declot procedure?
Will you talk about your room setup for a declot?
If you have a central stenosis do you go ahead and treat that after your central run?
Do you have a preferred device and how do you decide between 6 or 7 Fr?
After you handle the outflow what do you do next?
Talk us through your technique with the Fogarty in the artery
How do you avoid throwing clot into the arterial system?
Can you talk about angioplasty of or near the arterial anastomosis?
After treating the venous and arterial side what's next?
How much time are you willing to spend to clear the clot completely?
Do you find the devices help decrease procedure time and are there any disadvantages to using a device?
Tell us about your balloon angioplasty technique
Tell us about your approach to stenting
What do you do for closure and hemostasis?
For repeat or frequent declots, at what point do you decide to move to a surgical or catheter solution?
CME/CE Reflection: Module I
Can you describe the difference between fistulas and grafts for dialysis access?
When is a graft a better fit for a patient?
After surgical creation of an AV access how do you follow patients?
Do patients referred to you for dysfunction typically have a duplex ultrasound of the fistula or graft?
Tell us about the difference between inflow symptoms and outflow symptoms
Can you talk about your technique when approaching a fistula?
Tell us about how you use the Chameleon balloon for these cases
How do you approach an in-stent stenosis?
In what situations do you like covered stents?
What were the challenges of incorporating DCBs into your practice?
If you rupture a stenosis how do you manage it?
How do you follow these patients up?
At what point do you start to consider a surgical solution or new access?
CME/CE Reflection: Module II
Talk us through how you perform a basic fistulagram
Do most patients have an outflow issue?
Why do you go central and then work your way back to the access?
What constitutes a significant stenosis?
Do collaterals trigger you to do anything different or take a harder look?
Tell us about your approach to angioplasty in the dialysis circuit
What is a DCB and do you like them for the dialysis circuit?
Tell us about Impact vs Lutonix for DCB's
How do you use the DCB’s in the dialysis circuit?
What situations would you not use a DCB?
Are there any increased complications in adding the DCB to the algorithm?
What is the cost of drug eluting balloons?
How do stent grafts and covered stents fall into your algorithm?
Where in your practice do you use stent grafts?
When are you going to use a self expanding stent vs balloon expandable stent?
CME/CE Reflection: Module III
What do you need to know on the day of the procedure if they have a clotted dialysis circuit?
Are you using tPA and how much?
Do you start with the venous side or arterial side and what are you looking for on your central run?
When do you give heparin and how much do you give?
Once you have access what are the next steps?
When you-re doing your next run from the inflow what are you looking for and what do you do next?
Why do you have to be careful near the arterial anastomosis?
How often are you moving from a high pressure balloon to something more specialized?
How do you know when you-re done?
What do you do for closure?
When do you quit on a fistula?
CME/CE Reflection: Module IV
How do you approach the end stage vascular access patient?
What does HeRO stand for and what is it?
What patient population is the HeRO graft for?
Can you walk us through the procedure for placement?
Procedure steps of the HeRO graft cont-d
What is the biggest challenge with the procedure?
7. What kind of learning curve is there with this procedure_ (2_54)
CME/CE Reflection: Module V